The VA Disability-Claims Backlog…and the VA’s Response

Air Force and Iraq veteran Robert Fearing waited two-and-a-half years for the VA to award him disability compensation of about $1,800 a month for PTSD, which happened only after the Baltimore Sun reported on his case.

Since all issues are individually-evaluated medical conditions, they are likely a truer measure of the time it takes to complete a claim – and during that four-year period, the number of issues completed rose 136%.

The VA has been processing more claims – and more issues – than ever before. But such progress has been hard to see since the number of new claims — and the average number of issues per claim filed — grew even faster.

It’s simple arithmetic: the faster growth in applications than in processing swelled the disability backlog.

As of April 13th, 2013, about 852,000 claims were awaiting decision, and 69% (about 590,000) of those had been waiting more than 125 days – which is the VA’s official definition of a backlogged claim.

Contrary to the impression some give, severely wounded veterans of the current conflicts are not its bulk: of the claims awaiting action, 37% have been filed by Vietnam-era veterans, 23% by Gulf War-era veterans, and 20% by post-9/11 war veterans.

It’s also important to note that of all pending claims, some 40% are original claims while about 60% are supplemental – claims submitted by veterans seeking to increase their existing benefits or reopen a previously considered claim.

About half of all veterans with a pending claim currently receive compensation from VA.

Those being medically retired from the military today typically go through a new system, the Integrated Disability Evaluation System (IDES), and currently begin receiving VA benefits some 60 days after leaving the military. Those going through IDES are not included in the figures of pending claims.

Veterans who were medically retired due to the severity of their wounds recently (but before the IDES system) should already be getting military retirement payments and may also have qualified for a large one-time payment through the Servicemembers’ Group Life Insurance Traumatic Injury Protection Program (TSGLI).

According to Barry Jesinoski of Disabled American Veterans, a few weeks ago the VA’s Veterans Benefits Administration reached out to major Veterans Service Organizations. It described a proposal to make provisional decisions on the oldest claims more quickly, and participated in a frank and open discussion on ways to improve the plan.

Many of the VSO’s suggestions were incorporated, and starting last Friday, April 18, VA raters began making provisional decisions on the oldest claims on hand so the eligible veterans can begin collecting benefits more quickly. Veterans will then be able to submit additional evidence for another year before VA makes a final decision. More details are available here.

Partnering with outsiders.

In addition to VSOs, VA has brought in innovative business leaders like Craig Newmark of craigslist.org.

Even regular people like me are brought in: after noting gaps in VA’s ability to serve female veterans in my testimony before the Senate Veterans Affairs Committee, the VA appointed me to a term of service (now expired) on its Advisory Committee on Women Veterans.

The VA began rolling the new system out to regional offices late in 2012, and is in the midst of transitioning all regional offices over to the new system. That change will not be fast or easy, but it must be made.

The Stakeholder Enterprise Portal.

The SEP lets VSOs file claims and upload supporting documentation on behalf of the veterans they serve.

The contractor who developed the system met with VSOs and incorporated their input to improve how the system works and better meet the vets’ needs.

Segmented Lanes.

This is a method of matching certain categories of claims with the claims processors best suited to handle them.

Changing Acceptable Clinical Evidence.

ACE lets the VA use existing medical evidence already filed, instead of requiring a new medical exam, when possible.

“Challenge” Training.

A new means of honing claims-processors’ skills yielding faster and more accurate work.

The VA believes that under current disability rules, it will eliminate the backlog by 2015.

It’s also worth remembering that VA is not doing all this alone. Many overlook the Pentagon’s role.

The Department of Defense is a major component, and according to a recent VA-Pentagon information paper provided to the House Committee on Veterans Affairs, the Pentagon is a big part of the problem.

While awaiting processing, “the veteran’s claim sits stagnant for up to 175 days as VA awaits transfer of complete (service treatment records) from DoD,” the report notes.

After years of work to move toward integrated electronic records that would eliminate this sort of delay, Defense Secretary Chuck Hagel recently conceded that the Defense Department is not holding up its end of the bargain to improve the disability process.

“I didn’t think,” he said flatly, “we knew what the hell we were doing.”

As one who has been exposed and has done analytical statistic's knowing that using percentages is a way to paint a "better " Picture using broader strokes--by that I mean --if in this case the case load has improved 136% sounds terrific but if the starting number is [1] that means only 136 cases have been handled! That's the reality of using % verse's real numbers --gives one a warm and fuzzy feeling while in (FACT) very little has improved!